The Affordable Care Act and Primary Care Essay Example for Free

The Affordable Care Act and Primary Care Essay The purpose of this paper is to discuss the importance of providing increased access to primary care and the expected impact of the 2010 Affordable Care Act on the delivery of primary care in the United States, extending current trends through the year 2023. Addressed topics will include a brief overview of the Affordable Care Act, current state of primary care and the impact of the Affordable Care Act upon primary care patients, providers and payers. The Affordable Care Act In March 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (ACA) into law. This law makes preventive care, including primary care, family planning and other services more accessible and affordable for many Americans. According to the Center on Budget an Policy Priorities , the ACA would expand health care coverage to 32 million citizens who are currently uninsured. Expanded coverage of Medicaid and Medicare allows for increased inclusion of individuals who previously were not eligible for state and federal health insurance programs. The Medicaid expansion is 100% federally funded for the first three years (2014-2016) and at least 90% federally funded through 2022 and beyond (CBO, 2013). Included in the law is health insurance reform that makes illegal preexisting condition clauses in health insurance coverage and provides coverage for young adults under a family health insurance plan. Affordable Care Act and Primary Care 3 The uninsured and self employed would be able to purchase health insurance through state-based â€Å"exchanges†. Subsidies would be available to those who cannot afford to purchase insurance if they meet income requirements. Primary Care in the United States In the United States medical practice was not regulated until the 20th Century. Medical care was provided by a â€Å"doctor† who may or may not have been trained at a medical school. Many doctors received no formal training, learning as apprentices. These early practitioners provided a multitude of medical services to an entire family including delivering babies, setting fractures, surgeries, diagnosing and dispensing medications. Through organizations such as the American Medical Association the practice of medicine became regulated. These early pioneers were the early practitioners of primary care. Influenced by American ideals and desire for technology and wealth, the number of medical students choosing a path in primary care diminished in favor of specialty practice such as surgery, cardiology, radiology, etc. For several years there has been a decline in the United States primary care workforce. Primary care providers include general practitioners, general internal medicine practitioners, family physicians, physician assistants and nurse practitioners. The United States healthcare system has been facing a decline in its primary care Affordable Care Act and Primary Care 4 workforce, infrastructure and access to primary care services for several years. According to research (Petterson,2013) a number of factors, including poor reimbursements to primary care providers, low comparative income, and poor quality of work life due to high patient loads, have contributed to more providers choosing to train and practice in specialty medicine. This trend has led to a shortage of primary care providers across the country, likely contributing to fragmented care, inappropriate use of specialists, and less emphasis on prevention. Patients People who have access to a regular primary care physician are more likely  than those who do not, to receive recommended preventive services and timely care for medical condi ­tions before they become more serious and more costly to treat by visiting the emergency room instead of a primary care provider (Abrams, 2011). Patients are more likely to adhere to physician recommendations when seen by a primary care provider. Among low-income patients, access to primary care is associated with better preventive care, better management of chronic conditions, and reduced mortality. Preventing illness is as much a part of primary care as is the diagnosis and treatment of health conditions. The Affordable Care Act provides positive incentives to encourage people to obtain preventive primary care services. Through provisions in the act, applying to Medicare and Medicaid beneficiaries, as well as the privately insured, the law eliminates coinsurance, deductibles, and co payments for approved preventive services Affordable Care Act and Primary Care 5 and tests, such as blood-pressure and cancer screenings, mammograms and Pap tests, and immunizations. Studies have shown full coverage of preventive services with no patient cost, increases use of preventive screening services over time (Abrams, 2011). In a study of low-income patients, researchers found that even small incremental changes in co-payments had a substantial impact on the afford ­ability and utilization of care. Included in the ACA is the concept of a patient â€Å"medical home.† This is a pri ­mary care site that provides patients with timely access to care, including availability of appointments after regular office hours with patients to manage health conditions and prevent complications, coordinates all care, and engages in continuous quality improvement (Abrams, 2011). Primary care providers will be the coordinators of the medical home. These medical homes will also ensure greater coordina ­tion between the primary care site and local emergency departments. Primary Care Providers With the ACA the total number of primary care office visits is expected to increase from the 462 million visits in 2008, to 565 million in 2015. Also  expected is the need for an additional 52,000 primary care providers by 2025 due to insurance coverage expansion (Hofer, 2011). The ACA will entice primary care providers to accept more of the newly covered by increasing Medicare and Medicaid payments for primary care services. There are two Affordable Care Act and Primary Care 6 provisions in the ACA that augment payments to primary care providers, one provides a bonus to providers whom participate in Medicare, the second increases reimbursements for Medicaid participation. The goal of these financial incentives is to stabilize and expand the existing primary care workforce. The Affordable Care Act invests an estimated $3.5 billion in the primary care provider bonus program from 2011 to 2016. As a result, Medicaid primary care phy ­sicians are estimated to gain an additional $8.3 billion in reimbursement between 2013 and 2019 (Abrams, 2011). To address this growing shortage of primary care providers, the Affordable Care Act provides support of education and training for primary care providers and community health centers. The Affordable Care Act includes $1.5 billion authorized over 2011 to 2015 for the National Health Service Corps to provide scholarships and loan forgiveness for primary care physicians, nurse practitioners, and physician assistants practicing in health professional shortage areas (Abrams, 2011). Other provisions that offer financial support for training new primary care physicians include more favorable loan repayment require ­ments for the federally supported Primary Care Loan Program and a loan repayment pro ­gram for pediatric sub specialists and child or adoles ­cent mental or behavioral health providers working in underserved areas. The necessary midlevel primary care practi ­tioner is recognized through scholarships, loans, and loan repayment programs, as well as through the creation and expansion of training opportunities. Affordable Care Act and Primary Care 7 Payer The Affordable Care Act brings an unprecedented level of scrutiny and transparency to health insurance companies. The concept of an insurance exchange is a major component of the federal Affordable Care Act. An important component of the federal law is that individuals must have health insurance with federal subsidies to help them pay for it. To improve access and protect patient rights, ACA introduces new commercial insurance standards, such as the removal of medical underwriting, elimination of lifetime limits, prohibition of pre-existing condition exclusions, and removal of cost-sharing for preventive services. Insurance plans will be required to cover essential health benefits which are defined under the ACA (Rosenbaum, 2011). Insurance companies expect significant changes in enrollment, demographics, and plan types. Economic, behavioral, political, and strategic influences are expected to shape the changing insurance coverage landscape, according to a Department of Health and Human Services Report. Implications for insurance industry stakeholders are considerable, due to being regulated by state and federal government. Insurance companies and insurance trade publications are stating they will be forced to raise premiums due to ACA requirements, fess and taxes forced upon them ( DHHS,2013). The ACA imposes an annual fee or excise tax on most businesses that provide health insurance, starting in 2014. The fee will be raised proportionately each year among Affordable Care Act and Primary Care 8 insurance providers based on their share of the health insurance market (DHHS, 2013). Certain insurers are exempt from federal excise tax, including public charities and social welfare organizations. In addition, nonprofit insurers that receive more than 80 percent of their gross revenue from government programs that target low-income individuals, seniors, and people with disabilities (including Medicare, Medicaid, and the Children’s Health Insurance Program) are not subject to the tax. Supply and demand will determine how the excise tax is ultimately split between insurance companies and purchasers. Insurers have recently turned in strong financial results and thus are well positioned to bear some of the tax (DHHS, 2013). It is speculated they will pass a portion on to consumers. The Joint Committee on Taxation estimates that premiums subject to the fee will be 2 to 2 ½ percent higher than they would otherwise be. The Congressional Budget Office estimates that ACA will slightly reduce premiums for employer-sponsored health insurance in the near future. For employers with more than 50 workers, CBO estimates that the law will reduce average premiums by up to 3 percent in 2016. For small employers, the estimated change in premiums ranges from an increase of 1 percent to a reduction of 2 percent . It is important to note that the health insurance industry will gain millions of new enrollees in the next few years as a result of ACA. Insurance plans providing preventative health coverage will benefit financially by providing less expensive care for treatable Affordable Care Act and Primary Care 9 chronic conditions and early diagnosis on other medical conditions. Summary  With the oncoming implementation of the Affordable Care Act the benefits of the plan encourage the active role of the primary care provider. The uninsured patient now has access to health care that will afford him a better quality of life and address the financial implications of a poorly managed health care system in the United States. The ACA provides a means to entice more into the field of primary care. While it is in the early stages of scrutiny, the health insurance industry is a growing industry and is positioned to be profitable as a result of ACA, even with increased regulation. Conclusion With the implementation of the Affordable Care Act, the United States is positioned to provide a more sustainable and stronger health care system, due in part to the primary care provisions provided with the ACA. The health care system outlined would provide expanded service for patients, improve outcomes and quality and reduce future health care spending for the nation. References Abrams, M., Nuzum, R., Mika, S. and Lawlor, G. (2011, January). Realizing Health Reform’s Potential. The Commonwealth Fund. 1, 1-8. http://www.commonwealthfund.org/Publications/Issue-Briefs/2011/Jan/Strengthen-Primary-Care.aspx Center on Budget and Policy Priorities. (2013, July). Status of the ACA Medicaid Expansion After Supreme Court Ruling. Retrieved from http://www.cbpp.org Congressional Budget Office. (2013). CBO’s Estimate of the Net Budgetary Impact of the Affordable care Act’s Health Insurance Coverage Provisions Has Not Changed Much Over Time. (CBO Publication No. 144176). Washington, D.C. U.S. Government Printing Office. http://www.cbo.gov/publication/44176. Department of Health and Human Services. (2013, February). Health Insurance Premium Increases in the Individual Market Since the Passage of the Affordable Care Act. (DHHS. Research Brief). Washington, D.C. http://aspe.hhs.gov/health/reports/2013/RateIncreaseIndvMkt/rb.cfm Hofer, A., Abraham, J., Moscovice, I. (2011, March). Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization. Milbank Quarterly. 89(1): 69-89. http://www.milbank.org/publications/the-milbank-quarterly Patient Protection and Affordable Care Act, 42 U.S.C.  § 18001 (2010). Petterson, S., Liaw, W., Phillips, R., Rabin, D., Meyers, D. and Bazemore, A. (2013). Projecting US Primary Care Physician Workforce Needs: 2010-2025. Annuals of Medicine. 6, 503-509. http://annfammed.org/content/10/6/503.full Rosenbaum, Sara. (2013, February). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Reports. 126, 130-135. http://www.publichealthreports.org/

Of Mice And Men :: essays research papers

The same gun is used in the same manner to kill two beings, a smelly, old dog and a man named Lennie, in the novel "Of Mice And Men." This story deals with love and death while displaying an everyday scenario about friends and isolation. The symbols in this book represent the basic elements of human love. Some of the characters in this novel, such as Lennie, Crooks, and Curley’s wife, epitomize loneliness. Lennie, bearing his retardation, has trouble fitting in with the current workers at the ranch. Even though all the ranch hands praise Lennie for his hard work, they leave him out of nightly activities such as horseshoes. George, Lennie’s traveling buddy, is smart and fits right in with all of the employees of the ranch, adding to Lennie’s isolation. The black stable hand, Crooks, sleeps alone in a tiny room in the stable and is disliked by everyone except for Lennie. Since he is black, segregation is the ultimate reason why no one tries to like or befriend Crooks. Lennie, who, as an innocent person, has no bigotry in him, visits Crooks one night when everyone else is in town. Even thought Crooks does not show it, he enjoys Lennie’s company, and it seems that he and Lennie form a small friendship that would had developed more has the book been longer. Anot her soul not included with the ranch clique, Curley’s wife, whose name is not mentioned in the book, is new to the ranch as well. She married Curley just weeks before Lennie and George arrived. The ranch hands do not accept this lonely soul into their social group because she is new. However, the ranch hands also do not accept Curley’s wife because she obviously is so lonely that the only way she can get attention is by flirting. The only one who does not dismiss her when she flirts is Lennie who is obviously trying to make a friend with another lonely person. These lonely individuals make this novel into a very sad story of real life situations of when people really do not "fit in." The idea of obtaining a little farm with animals and crops raised by George and Lennie, and later joined by Candy, an old man, shows how dreams may cause a man to do anything to fulfill that dream. Lennie is the most enthusiastic and determined to gain the small farm and the all-important things -- the rabbits.

Research Ethics

A research study is defined as an activity involving collection of data with an aim of solving a specific selected problem. The above is followed by recording of the data then subsequently its analysis so as to arrive at meanings. Finally the results are generalized so as to make the findings applicable to whole populations and therefore deductions as well as suggestions also known as recommendations. Finally the researcher makes conclusions which are an opinion which expresses the researchers stand concerning the research problem. A researcher should ensure that the suitable data collection instruments and methods are used. The suitable data analysis techniques should be employed so as to enable the researcher draw the relevant conclusions of a study. A research study involves costs, which are incurred in various ways including data collection, carrying out interviews as well as costs associated with data analysis. In any given research study there is usually an involvement of usually three or more groups of participants. The participants include the researcher, the respondent and the sponsor. For a marketing research, the sponsor is usually the supplier. Research studies require that some ethical norms be considered to ensure that the research being carried out is meets ethical standards as well as regulations guiding various professions. These ethical norms are usually observed with reference to the rights and obligations of each participant in a research. In any given study, the researcher is supposed to adhere to ethical norms something aimed at ensuring that, the research does not interfe with peoples fundamentals rights no harm the research subjects in any way. All particiapants in a research are required to adhere to the given regulations in their interactions amongst themselves as well as in their interactions to the public in whose midst the research is conducted. When handling the respondent a researcher should apply certain ethical norms in order to observe and guarantee the respect of respondent’s rights. Such respondent’s rights in an interview can include amongst others: (i) Informed consent – it’s the right of the respondent to be informed about a certain research to be carried out and that the respondent is supposed to be a participant. The researcher is obliged to respect the respondent and give details of the research study. With an informed consent, the relationship between the researcher and that of the respondent is enhanced something which results into a good working rapport hence contributing to the success of the research study. Incases of lack of consent before a research begins co-operation lacks in the data collection process and therefore chances that the data gathered may be unreliable become high. (ii) Confidentiality – Ethical norms dictate that the respondent should be treated with a sense of confidentiality in handling the respondents’ information. The respondents’ information should not be exposed to third parties or used for purposes other than those for which consent was sought for. The information obtained from the respondent should be given to the right person. Incase of a marketing research the supplier should get the information. The researcher should make sure that he/she remains truthful and ensure that he /she does not expose the respondents’ information (Dooley, 2002, P160-170). (iii) Anonymity – It is the right of the respondent to maintain his or her anonymity. Anonymity refers to the concealing of the respondent’s identity. It is the right of the respondent to decide about his identity hence the researcher should respect that decision. The researcher should not disclose the identity of the respondent when the instructions demand so. The researcher should posses the value of promise keeping so as to succeed (Emerson 1990, P89-103) The researcher should be able to be responsible when handling the respondents’ identity. He/she should not be able to misplace any documents containing the respondents details this would contravene the respondents right to immunity. The researcher should be honest to the extent of involvement of respondent in the research study. The researcher should inform the respondent whether there is any risk of harm involved. This will help the respondent in preparing himself or herself. This honesty should not be compromised. This point to the obligation of the researcher in taking into consideration the respondent’s safety. The researcher has the obligation towards the research staff. Ethical issues will enable him or her handle the research team as per the ethical norms (Gray 2003 p 67-83) The researcher should be honest towards the research staff in terms of their remuneration. The researcher should also consider the safety of the research team. He or she should ensure that no acts of negligence or carelessness should occur which might cause safety risk of the research team. The researcher should also ensure that he or she practices patience while handling the respondent, the research team and also the sponsor (incase of a market research study; the supplier) Patience will be required in negotiations and discussions since a research study mostly involves teamwork. Each participant in a research study usually has a set of obligations to be taken care of. The researcher usually has an obligation towards the supplier who is the sponsor of a research study. The researcher is supposed to achieve these obligations through the guidance of ethical norms. The obligations of the researcher to the sponsor executable through application of ethical norms include: (i) Obligation to submit a conclusive research study worthy of the cost paid. The sponsor usually takes more of the research cost; therefore the researcher has to submit research work, which is worthy the amount paid for. To succeed in these obligations the researcher should remain honest. The researcher should be ready to account for the research project to the satisfaction of the sponsor; In the case of a marketing research the supplier ***** (ii) The researcher has the obligation of submitting the researcher has the obligation of submitting the research work within the specified time frame. This obligation requires that the researcher posses the quality of commitment. The researcher should be truthful in giving the expected time for completion of the research work. (iii) The researcher has the obligation of submitting research work of the right quality. The supplier or sponsor will expect the researcher to carry out a research study, which serves the purpose. This will include use of the suitable data collection methods, proper analysis and reasonable conclusions drawn. The supplier (sponsor) will expect the researcher to provide him or her with the suitable data evaluation techniques so that he may be able to understand well the research work (flick 1983 p 10-26) We must be aware of the fact that the sponsor who is usually the supplier in a market research study has an obligation towards the researcher. The sponsor has to be honest towards the researcher in terms of the scope of the research work required. He should not exaggerate on details required in a research study, which might be out of scope. Failure to be honest the researcher will definitely submit irrelevant information upon research (Johnson 1985 p 17-36) The supplier (sponsor) should remain truthful about the research costs. The sponsor should clear the costs of research and also remunerate the researcher. The supplier should not create complications after the research work has been completed. This would contravene the researcher’s right of remuneration. CONCLUSION Research studies are aimed at alleviating certain problem or learning more about a specific problem. For any research study to be successful the participants should be able to co-operate well towards attainment of the research objective. This co-operation will be brought about by each participant playing his or her role under the guidance of the ethical issues required in a research study. The ethical issues shouldn’t be largely dependent on the specific participants’ rights and obligations.

Miguel de Cervantes, Influential Spanish Novelist

No name is more associated with Spanish literature—and perhaps with classic literature in general—than that of Miguel de Cervantes Saavedra. He was the author of El ingenioso hidalgo don Quijote de la Mancha, which is sometimes referred to as the first European novel and which has been translated into nearly every major language, making it one of the most widely distributed books after the Bible. Cervantes Contribution to Literature Although few people in the English-speaking world have read Don Quijote in its original Spanish, it nevertheless has had its influence on the English language, giving us expressions such as the pot calling the kettle black, tilting at windmills, a wild-goose chase and the skys the limit. Also, our word quixotic originated from the name of the title character. (Quijote is often spelled as Quixote.) Despite his immense contributions to world literature, Cervantes never became wealthy as a result of his work, and not much is known about the early parts of his life. He was born in 1547 as the son of surgeon Rodrigo de Cervantes in Alcalà ¡ de Henares, a small town near Madrid; it is believed that his mother, Leonor de Cortinas, was the descendant of Jews who had converted to Christianity. A Brief Biography of Cervantes As a young boy Cervantes moved from town to town as his father sought work; later he would study in Madrid under Juan Là ³pez de Hoyos, a well-known humanist, and in 1570 he went to Rome to study. Ever loyal to Spain, Cervantes joined a Spanish regiment in Naples and received a wound in a battle at Lepanco that permanently injured his left hand. As a result, he picked up the nickname of el manco de Lepanto (the cripple of Lepanco). His battle injury was only the first of Cervantes troubles. He and his brother Rodrigo were on a ship that was captured by pirates in 1575. It wasnt until five years later that Cervantes was released — but only after four unsuccessful escape attempts and after his family and friends raised 500 escudos, an enormous sum of money that would drain the family financially, as ransom. Cervantes first play, Los tratos de Argel (The Treatments of Algiers), was based on his experiences as a captive, as was the later Los baà ±os de Argel (The Baths of Algiers). In 1584 Cervantes married the much younger Catalina de Salazar y Palacios; they had no children, although he had a daughter from an affair with an actress. A few years later, Cervantes left his wife, faced severe financial difficulties, and was jailed at least three times (once as a murder suspect, although there was insufficient evidence to try him). He eventually settled in Madrid in 1606, shortly after the first part of Don Quijote was published. Although publication of the novel didnt make Cervantes rich, it eased his financial burden and gave him recognition and the ability to devote more time to writing. He published the second part of Don Quijote in 1615 and wrote dozens of other plays, short stories, novels, and poems (although many critics have little good to say about his poetry). Cervantes final novel was Los trabajos de Persiles y Sigismunda (The Exploits of Persiles and Sigismunda), published three days before his death on April 23, 1616. Coincidentally, Cervantes date of death is the same as William Shakespeares, although in reality Cervantes death came 10 days sooner because Spain and England used different calendars at the time. Quick — name a fictional character from a literary work written about 400 years ago. Since youre reading this page, you probably had little difficulty coming up with Don Quijote, the title character of Miguel de Cervantes famous novel. But how many others could you name? Except for characters developed by William Shakespeare, probably few or none. At least in Western cultures, Cervantes pioneering novel, El ingenioso hidalgo don Quijote de la Mancha, is one of the few that has been popular for so long. It has been translated into nearly every major language, inspired some 40 motion pictures, and added words and phrases to our vocabulary. In the English-speaking world, Quijote is easily the most well-known literary figure who was the product of a non-English-speaking author in the past 500 years. Clearly, Quijotes character has endured, even if few people today read the entire novel except as a part of college coursework. Why? Perhaps it is because there is something in most of us that, like Quijote, cant always distinguish totally between reality and the imagination. Perhaps its because of our idealistic ambitions, and we like seeing someone continuing to strive despite the disappointments of reality. Perhaps its simply because we can laugh at a part of ourselves in the numerous humorous incidents that happen during Quijotes life. A Quick Look at Don Quixote Here is a brief overview of the novel that might give you some idea what to expect if you decide to tackle Cervantes monumental work: Plot Summary The title character, a middle-aged gentleman from the La Mancha region of Spain, becomes enchanted with the idea of chivalry and decides to seek adventure. Eventually, he is accompanied by a sidekick, Sancho Panza. With a dilapidated horse and equipment, together they seek glory, adventure, often in the honor of Dulcinea, Quijotes love. Quijote doesnt always act honorably, however, and neither do many of the other minor characters in the novel. Eventually Quijote is brought down to reality and dies shortly thereafter. Major Characters The title character, Don Quijote, is far from static; indeed, he reinvents himself several times. He often is a victim of his own delusions and undergoes metamorphoses as he gains or loses touch with reality. The sidekick, Sancho Panza, may be the most complex figure in the novel. Not particularly sophisticated, Panza struggles with his attitudes toward Quijote and eventually becomes his most loyal companion despite repeated arguments. Dulcinea is the character that is never seen, for she was born in Quijotes imagination (although modeled after a real person). Novel Structure Quijotes novel, while not the first novel written, nevertheless had little on which it could be modeled. Modern readers may find the episodic novel too long and redundant as well as inconsistent in style. Some of the novels quirks are intentional (in fact, some portions of the latter parts of the book were written in response to public comments on the portion that was published first), while others are products of the times. Reference: Proyecto Cervantes, Miguel de Cervantes 1547-1616, Hispanos Famosos. Quick Takeaways Miguel de Cervantes was one of the most influential writers of all times, writing the first major European novel and contributing to both the Spanish and English languages.Although known best for Don Quijote, Cervantes also wrote dozens of other novels, short stories, poems, and plays.The main characters of Don Quijote are the title character; his sidekick, Sancho Panza; and Dulcinea, who lives in Quijotes imagination.